Your head is throbbing, your stomach is queasy and bright lights or loud noises make you feel even worse. If you’re one of 36 million Americans who get migraine headaches, you’re familiar with these classic symptoms of an attack. Read on for expert help for migraines, including possible causes, treatments and other resources...

Although “migraine” is often used to describe any splitting headache, a true migraine headache has distinctive characteristics, according to the Migraine Research Foundation. For one thing, the pain is typically moderate to severe, with a throbbing or pulsating feeling.

A migraine attack generally lasts between four and 72 hours, but in some cases, it can last an entire week.

In about 60% of cases, the pain centers on one side of the head and face.

An aura, a reversible neurological symptom, may occur shortly before or at the onset of pain and last 5-60 minutes. During an aura, a person may feel mentally “fuzzy” or have an altered sense of smell, taste or touch, says UK-based The Migraine Trust, an educational, support and research organization.

The most common type of aura involves visual changes – blind spots, flashing lights, specks or wavy or shimmering lines, usually in just one side of your visual field.

Less common are sensory auras, which involve numbness or tingling in the hands or face, or language auras, in which people have trouble speaking.

“Only about 20% of migraine patients will experience an aura,” says neurologist Brian M. Grosberg, M.D., director of the Montefiore Headache Center in New York City.

When headache pain is accompanied by speech difficulties, he says, it’s important to rule out other serious conditions such as stroke and seizures, which can cause similar speech and language problems.

Migraines occur most often in adults between the ages of 25 and 55, and they are three times more common in women than men, according to the Migraine Research Foundation.

It’s not understood why, but experts say the hormone estrogen plays a role.

Many women have migraine attacks around the time of their periods or find their attacks are more severe then.

“Research shows that normal hormonal fluctuations associated with menstruation trigger migraines for many women,” says Ana Recober-Montilla, M.D., assistant professor of neurology at University of Iowa in Iowa City.

Many other things can trigger migraine attacks, Dr. Grosberg says. These include certain foods (such as red wine or chocolate), dehydration, changes in weather or altitude, hormonal fluctuations, stress, lack of sleep, and even bright sunlight or strong odors, such as perfume.

“Not every person with migraines has triggers,” he says, “but some people have multiple triggers.”

But a migraine trigger is not the same thing as a migraine cause, says headache specialist Frederick G. Freitag, D.O., associate professor at the Medical College of Wisconsin.

“Migraine is almost certainly inherited and definitely familial. Once you have the tendency towards migraine, then a variety of triggers can result in attacks,” he says.

There’s no doubt that migraine headaches are debilitating and interfere with daily activities. But migraines often go undiagnosed or misdiagnosed for months or years.

Of 130 migraine patients, more than 80% were misdiagnosed as having sinusitis, according to a 2013 study published in The Journal of Headache and Pain.

To manage your migraine, a critical first step is to keep a detailed headache diary of the days and times you experience migraine pain, how long the headaches last, as well as possible triggers, such as foods, lack of sleep or where you are in your menstrual cycle.

Without such a diary, “the patient may not be able to give an accurate picture of their migraines, and the doctor may not get a true sense of their severity and how they affect a person’s quality of life,” Dr. Grosberg says.

Help for Migraines

Medication. When it comes to migraine treatments, “one size doesn’t fit all,” Dr. Grosberg says. “No two people will have the same migraine, so treatment needs to be tailored to each individual.”

Migraine medication falls into two categories: acute and preventive:

Pain-relieving, or “acute” medications, taken at the onset of symptoms, work by interfering with the neurological pathways that cause pain and other symptoms. Aspirin or nonsteroidal anti-inflammatory drugs (such as Advil), as well as acetaminophen (Tylenol) may help relieve mild migraines, says the Mayo Clinic. Over-the-counter migraine drugs that contain a combination of aspirin, acetaminophen and caffeine (Excedrin Migraine), may also be effective. The most commonly prescribed acute drugs are medications known as triptans, which help constrict blood vessels.

If migraines occur at least once a week, or you’re having attacks that last for several days, or you’re constantly worried about when the next one is going to hit, your doctor may recommend a preventive medication. These include beta blockers, calcium-channel blockers (approved by the Food and Drug Administration to treat high blood pressure but frequently prescribed “off-label” to treat migraines), anti-seizure medications and antidepressants. (Botox may also offer migraine relief.)

“With daily prevention medications, the goal isn’t to cure them, but to cut the frequency by at least 50%,” Dr. Grosberg says.

The FDA just approved a new migraine-prevention device, called Cefaly. It works by stimulating the nerves associated with migraine headaches.

“Cefaly provides an alternative to medication for migraine prevention,” said Christy Foreman, director of the FDA’s Office of Device Evaluation. “This may help patients who cannot tolerate current migraine medications.”

The small, portable, battery-powered device is worn like a headband across the forehead. It is used once daily for 20 minutes.

Migraine sufferers who used Cefaly experienced significantly fewer migraines than those who used a placebo device, according to a 67-person Belgian study. However, the device didn’t completely prevent migraines and did not reduce the intensity of migraines that did occur, says the FDA.

The agency also has allowed the marketing of Cerena, another prescription medical device, to ease pain caused by migraines preceded by an aura. The patient holds the device with both hands against the back of the head and presses a button to send a magnetic pulse to stimulate the area of the brain that processes visual information.

Both devices provide an alternative to medication, which can be overused. Patients who overuse acute migraine medications often get rebound headaches.

“I see rebound headache in about 90% of those who have migraines more than 15 days per month,” Dr. Freitag says.

Even something as common as caffeine can cause rebound headaches, he says, because it’s in so many over-the-counter and prescription medications, and in people’s diets.

To stop rebound headaches, your doctor may have you quit medications cold-turkey, or gradually reduce the dose. You may also need to take another type of medicine to deal with withdrawal symptoms, says the Mayo Clinic.

It’s not the stress itself that makes your head hurt, new research shows. Rather, a migraine is likely to occur when sky-high stress levels suddenly plummet (for example, think of how your stress dramatically dips right after you finish a job interview or important test).

When 17 migraine sufferers kept a three-month daily diary to record the ups and downs of their stress levels, researchers at the Montefiore Headache Center and Albert Einstein College of Medicine discovered “a striking association between reduction in perceived stress and the occurrence of migraine headaches,” said study lead author Richard Lipton, M.D., director, Montefiore Headache Center, and professor and vice chair of neurology, Einstein.

Migraines were five times more likely to occur during the first six hours after a sudden reduction in stress, according to the 2014 study, which was published in the journal Neurology.

To keep stress levels at a more even keel, find ways to relax during times of stress. Do some yoga, take a walk, or try deep breathing.

Biofeedback using both hand-warming (which shifts blood flow away from the head) and muscle relaxation (which addresses muscle tension) reduce migraines and also “control a migraine as it comes on, to eliminate or reduce the need for acute treatment medicines,” Dr. Freitag says.

Regular exercise can also be beneficial.

“Brisk walking for 20 minutes four days a week boosts production of the body’s natural pain killers and may reduce migraine frequency,” Dr. Freitag says.

But don’t try to exercise during a migraine attack because that can make symptoms worse, he says.

Maintaining a healthy weight is also important.

While people with normal weight have a 3% chance of developing chronic (at least every other day) migraines, those who are overweight have triple the chance.

And as weight goes up, so does chronic migraine risk: Those who are obese have a fivefold likelihood of having chronic migraines, according to the American Headache Society.

Less frequent migraines are also almost twice as common among obese people, according to a 2013 study of nearly 4,000 adults, published in Neurology. Those who were obese were 81% more likely to experience episodic migraines than those of normal weight.

The obesity-migraine connection was especially high among women, those under 50 years old, and those who were white.

Why the weight-headache connection?

It’s not known, but overlapping neurological pathways that regulate feeding and migraines may play a role, according to the American Headache Society.
More Migraine Resources

Dr. Recober-Montilla recommends the following online sources for more information about migraines as well as other types of headaches:

How Much Do You Know About Migraine Headaches?
In the U.S. alone, 30 million people suffer from migraine headaches, and the condition is three times more common in women than in men. However, surveys show that fewer than half of sufferers have received a diagnosis from their health-care providers. Do you or someone you know get migraine headaches? Test your knowledge with our migraine quiz.

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